And There Was No Sick Among Them

“And remember in all things the poor and the needy, the sick and the afflicted, for he that doeth not these things, the same is not my disciple.”  D&C 52:40

I remember the day – 10 years ago this month –  I first realized that government-sponsored healthcare might not be inherently evil.

A British friend and I were engaged in an impromptu debate on social policy.  I started lecturing him on the defects of British healthcare compared to true red-state and Mormon principles of self-reliance.  Any form of welfare, especially government-sponsored healthcare, perpetuated a cycle of dependence.  If an individual legitimately needed help, family, friends, and nonprofits should step in.  Government involvement was wasteful, anti-capitalistic, and coercive –  it could never heal society.

He offered a pithy response: “I can think of nothing more barbaric about America than that you let people die because they can’t afford healthcare.”

“Barbaric” hit me with a jolt. What an absurd word!  And yet, one with truth.

Do I want sick people to die? Of course not. 

 Do I want sick people to be forced into bankruptcy just so they can live? Don’t be ridiculous. 

 Do I want to make sick people forego basic checkups and medicines, which might prevent worse outcomes, because they can’t afford them?  That’s just cruel.

My red-state, free-market, “Christian,” upbringing had taught me to ask the wrong question.  The question wasn’t: “how can I make sick, sinful, slackers take responsibility for their lives?” Rather, I should be asking: “how can I build a society that helps the poor, the sick, and the vulnerable?  How can I better support life?”

The sick aren’t sinners who deserve illness and death; they’re Children of God who deserve healing and life.

In my scripture study I confronted that message everywhere.  God called Christians to heal, not just by giving Priesthood blessings, but by building compassionate communities.  Christ constantly reminds us that no wealth, no social status, no righteousness makes us better than our neighbors.  All have sinned and fallen short of the glory of God; all are less than the dust of the earth.  Prophets call to repentance not only prideful individuals but also prideful societies.

“Thus saith the Lord God unto the shepherds; Woe be to the shepherds of Israel that do feed themselves! should not the shepherds feed the flocks?  Ye eat the fat, and ye clothe you with the wool, ye kill them that are fed: but ye feed not the flock.  The diseased have ye not strengthened, neither have ye healed that which was sick.”  Ezekiel 34:2-4

I was beginning to understand the “Christian left.”

But I refused to become a bleeding-heart liberal.  So I searched for ways to make the conservative, economic case for expansive healthcare.  Healthcare is like infrastructure, or education, I reasoned.  It’s a common good; an investment in the future.  I ate up stories about various experiments with free children’s coverage, free vaccines, and free birth control.  In the long run, these upfront investments were often resulting in better health and cheaper costs.  Simply put, government could provide healthcare more expansively, more efficiently, and more cost-effectively than patchworks of private industry and charity.

Sure, government is cold, dispassionate and bureaucratic, I acknowledged, but it’s a reasonable choice for voters to choose to outsource healthcare to the government, in order to achieve more comprehensive results.

That position became my stock response in Sunday School whenever political condemnation of Obamacare infiltrated class discussions.  “Let’s step back and acknowledge the good intentions here,” I regularly countered.  “Those who support government healthcare do so because they genuinely want to care for the poor and needy. They want fewer of their neighbors to be sick.  I can think of nothing more Christ-like.”

A few weeks ago I was chatting politics with a New York-liberal friend when I fell back, once again, on my “the government is dispassionate but efficient” argument.  He looked bemused (it’s a long-running trend that every argument I make circles back to “efficiency”).  Then he offered a response that once again, changed my entire paradigm.

Dispassion is a virtue, not a flaw.

As he explained it, the problem with patchworks of private charity is that they invariably end up benefiting the cute, the familiar, and the sympathetic.  Those who can pull at media and social media heartstrings benefit in a private charitable system; everyone else falls through the cracks. Those without family as backstops; those without friends who can afford to contribute to GoFundMe accounts; those without the marketing prowess to appear faultless except for their sickness; those who suffer the effects of unconscious bias; those who are unemployed or homeless or disabled or mentally ill; they are left out of a system structured around private generosity.

We may wish for a world where every one of us has the Christ-like compassion to succor every person who asks, regardless of our emotional judgment of whether that person “deserves” or has “earned” our help.  But that is not the world we live in.  And even if we always did chip in, that alone would not be enough to cover everyone in need.  Too many of us with wealth are too far removed from the social circles of those needing help to even hear their pleas.

That’s why the social safety net is so valuable.  Bureaucracy does not depend on heartstrings.  It is built upon trained professionals, asking objective questions, filling out dispassionate forms.  What’s your income level?  How many children do you have?  What healthcare do you need?  In many “universal healthcare” countries, even those questions are irrelevant, at least for basic services.  They simply ask Are you sick? Here is treatment.

Any human system will always be imperfect, but let us always strive to make it better, not worse.

As Christians, we should have one goal in sight:   “And the Lord called his people Zion, because they were of one heart and one mind, and dwelt in righteousness; and there was no poor among them.”  Moses 7:18.  Neither should there be any among Zion who are sick.

 

Comments

  1. I think is article makes a good point about the benefit of a bureaucracy that can impartially administer aid. But there are two distinct negatives as I see it. First, in reality government is not the dispassionate neutral force described. Government picks favorites based on groups in power and will systematically distort the system for the in-groups benefit. Second, by making health care funding or taxation in general more invisible (through pay-roll taxes etc.) it becomes very difficult to have any sense of what your money is going towards and how you are helping people. The distance from giver to receiver creates a sense of entitlement (to paraphrase Elder Reunland) not only in the receiver but also in the giver. I wonder If there isn’t some way to reduce the distance between giver and receiver. The Church does a generally good job at this with how it administers its social welfare programs, though I admit that I have little direct sense of how my fast offerings go to help concrete individiuals. So we can probably do better with this as well.

  2. What this makes me think of: When I was a young Catholic school student, I saw banners on each school that said: “This school saves taxpayers $____ per student. Last year, this school saved taxpayers $____ per year.”

    The government recognizes that education is essential for all of its citizens. Private institutions, churches, charities and individuals can’t do it all. What they can do is lift where they stand and defray what the government spends.

    It should be the same with health care. It is a basic essential for all Americans. Private institutions, churches, charities and individuals can do their part to alleviate the government’s burden. But the burden is on the government to ensure basic care for all. How that’s done is a matter of fair and honest debate, but it must be done.

  3. Elizabeth says:

    symphonyofdissent: Volunteer at a Bishop’s Store house if you possibly can. It will make it very clear to you just how much some of your fast offerings help people. A year of working there changed my whole perspective on fast offerings. It makes a tremendous difference for many people, and I feel very humble to think I can help even a little bit. When a sister came back in after her car was loaded just to give me hug for doing nothing more than helping her fill her order, I was overcome with emotion. It is needed, and it is appreciated.

  4. jaxjensen says:

    Look… the old “Zion though Gov’t programs” idea again.

    Could we get a show of hands of how many want the Gov’t to be pushing Christian/Zionist principles? I’ll not be counting, but if someone else is, count me as a NO please.

  5. Chadwick says:

    It irks me how in America we “other” the government. My parents were public school teachers; my brother works for the BLM; my brother in law is a UHP officer. They are all of them good people. And they are part of our government. They don’t thrive on inefficiency, they don’t enjoy red tape, and they don’t delineate their customer base on political leaning. Surely they could do more if we only stopped freaking out about big brother and instead realized that we the people. We can administer need just as well as any profit seeking corporation can.

    I loved this post! I appreciate your insight into your journey of change; though my story is different, the beginning and ending are quite similar. Thank you for sharing.

  6. Look, commenters comparing safety nets and health care to Zion. Count me out of that view of Zion!

  7. And to third the OP and Chadwick: different story for me, but same beginning and end.

  8. Kelly Beutler says:

    Amen!

  9. Carolyn says:

    @symphony: Any ideas on how to collapse the distance between giver and recipient? The first one that comes to my mind is adding an optional feature into TurboTax that roughly breaks down your taxes by government spending.

    I.e. of a $10,000 income tax bill, 4,000 will be spent in healthcare, 4,000 will be spent on the military, 500 on infrastructure, 500 on education, 1000 on all other government programs. Then it could pop up and ask you what your highest priorities are. And if you say “children’s health” or “homes for veterans” or “education,” it could pop up with a list of top rated charities in those fields. Simultaneously you can donate money to (or look up volunteer opportunities with) them and reduce your tax burden!

  10. Carolyn says:

    To those saying you don’t want Zion to include government support…a few questions.

    One: We do agree that sick people should be able to go to doctors, yes?

    Two: Assuming so, what do you view as the best way to facilitate that?

    Three: You do realize that at the end of the day, a church is a government, yes? The principles of organizational behavior, etc. are the same. As soon as you systemize rules and processes and funding, including for helping individuals and communities in need, you’ve created a government. When Utah was essentially a Mormon-run territory in the 19th century following the United Order, the difference between Church aid and Government aid was effectively nil.

    So I get that you don’t want the “Government” to be co-opted by any one religious view. (Goodness knows I don’t either, huge fan of the Establishment Clause that I am.). But providing healthcare isn’t just at the end of the day grounded in Mormon doctrine, or in Christian doctrine, or in religious doctrine of any sort — even as those doctrines champion caring for the poor and needy. It’s basic human decency and should be fundamental to any social contract upon which any government is based. (Thanks Rousseau!)

  11. Obamacare, which roughly resembled Romneycare in Massachusetts, is still the law of the land, and I don’t see how 60 votes will be found in the Senate to repeal it. From the original post one might think that Medicaid, Medicare, Obamacare, the VA, and numerous state programs weren’t on the books. One might think from the original post that the federal governments didn’t spend in excess of $980 billion on health care in 2015. Our healthcare system is far from perfect, but we have been spending a lot of tax dollars on it for years, and those expenditures are increasing. That isn’t going to change any time soon. Federal spending on healthcare isn’t new or leftist. It’s very much in the mainstream and has been for over half a century.

    Americans still get sick, though. In fact, American life expectancy is declining. Obamacare is not responsible for that, of course, but the original post ignores the complexity of achieving to goal of “no sick among them.”

  12. I cannot believe how you Americans agonize over “socialized medicine” and how to set up a reasonable health care system. Look to Canada. I know it isn’t perfect but it is very good. Look at Britain, again a system that provides medical care for all. A while back I needed arthroscopic surgery on my knee. Wait time, 6 months. Cost to me? Nothing! While living in Britain I was diagnosed with Basal Cell carcinoma on my ear. It was removed after a 2 month wait. Cost? Nothing. Last year I had my cataracts corrected and new lens put in. At the same time I had a cornea transplant for both eyes. The corneal material had to be purchased from the US because there was not enough corneas to meet the demand. Wait time 3 months. Cost to me: nothing.
    What would those procedures have cost under the American system?
    All permanent residents of Canada are covered, even the refugees we admit to the country. The poor, the marginalized, everyone is covered. Is it perfect? No, but it is certainly much better than the uncaring, unChristian system in place now.
    Sorry to rain on your parade.

  13. Deborah Christensen says:

    @ symphonyofdissent: you stated “First, in reality government is not the dispassionate neutral force described. Government picks favorites based on groups in power and will systematically distort the system for the in-groups benefit.”
    You just described the church’s welfare system. I’m saying this as a RM and former RS president of 5 years. I’ve also worked as an nurse for 15 years and seen how other church/charitable agencies operate. It’s all the same

  14. Government may not be even-handed. But there is at least some accountability — voters and a judicial system that protects rights, even of the unpopular. Philanthropists are accountable to no one.

    On the comment that distance creates a sense of entitlement. This sounds like the kind of thing that conservatives like to say. Is there any evidence of this? In my personal experience, it’s not true. I grew up in Canada with socialized medicine. I didn’t feel a sense of entitlement and I didn’t notice entitlement running rampant through the population. I’m not sure Danes, or Finns, or Swedes are particularly high on the entitlement scale either. Before I buy into a statement like that, I’d want to see some evidence — preferably from a randomized field study.

  15. I come at this issue building up from the fundamental economics of health care. In a one-liner, in any given year about 5% of patients account for about 50% of health care costs (in the United States). It’s not the same 5% every year, and the numbers are significantly overweighted to the very young and the very old. This means to me that health care rationalized on an individual self-reliance basis means the young and the old die prematurely. Assuming that is unacceptable (count me in the “unacceptable” boat) we will always and forever have to treat health care as some form of collective good, through large-scale insurance schemes (which require large groups of not self-selected people paying a normalized amount, and therefore some requirements or compulsion about participation), and/or public good/tax/redistribution analysis.

    When considering the pros and cons of insurance schemes and public good/tax/redistribution, be sure to include as needing to continue or be replaced (because it’s not going to just disappear) the current U.S. hodge-podge of Medicare/Medicaid/Children Health Insurance Program, the tax subsidy for employer-provided health insurance (covering about 57% of the population under 65), as well as the Obamacare subsidy for certain health insurance. For the under-65 population we are currently ‘spending’ $660 billion at a federal tax level (approximate; 2016). Note that more than 95% of that is *not* Obamacare (where the direct subsidy was on the order of $25 billion in 2015). And if we really dig in, let’s consider tax subsidies to hospitals that provide emergency care, that serves as the principal backup medical system for the uninsured.

    All else being equal, smaller and closer is likely to be more efficient and better tailored. But dispassion is important too (finally back to the OP). Unfortunately, in the United States at least the evidence of post-Civil War Reconstruction to present is that the Federal government is better at dispassion than the several States, pushing us to a federal system. Also, as noted above, the LDS church welfare system is not a counter-example but rather a quite selective preferential system (“Generally, a bishop assists only those members who currently live within his own ward’s boundaries On rare occasions the bishop, under the inspiration of the Spirit, may assist individuals who are not members of the Church.” And my own experience is that worthiness standards come into play and.the system is in many cases heavily weighted in favor of active dependable members.)

  16. I’m an American who has contributed to the social welfare system of my host country for over ten years. While that doesn’t make me particularly qualified to weigh in on policy issues, I am someone with skin in the game.

    In principle, a single level of high quality care is available to all and there is no such thing as a pre-existing condition when it comes to coverage. Costs are predictable and consistent–everyone pays the same percentage of their income if employed and none if unemployed. Administration is efficient–my carrier claims administrative costs of just 2%.

    It’s not all sweetness and light, however; in fact, the biggest problem that I can see is the push to make the system more “American,” i.e., where the quality of care is tied to your ability to pay. Where I live there isn’t actually a single payer–I think there are 16 public insurance carriers–but you don’t get to freely choose who you are covered by–you are assigned one based on your profession or place of residence–and while the percentage of income one pays is uniform, the benefits actually vary somewhat (the carriers that are based on professions, for example, generally have healthier, fully employed higher earners than the regional carriers who get left with whomever is not otherwise covered and can reimburse doctors at higher rates). Also contributing to the rise of “class medicine” is the proliferation of private insurance policies promising more comprehensive coverage and comfortable treatment (e.g., single occupant hospital rooms) that dance around the principle above that all receive the same level of care. Finally, cash talks in this society as elsewhere and so queues can be jumped with the right connections.

    It’s not perfect, but I wouldn’t trade it for the byzantine system that has been cobbled together over the years in the US where you are more often than not at the mercy of your employer’s group plan, your life savings or the generosity of your neighbor.

  17. Truly wonderful and true post. Amen to everything about it.

  18. The argument that “we can’t use the government to bring about Zion,” which seems to crop up any time that somebody suggests that feeding people and helping them get health care, is flawed in so many directions at once that it is hard to separate out all of its various levels of badness. But here are two.

    1. It assumes that the government can do nothing. The idea that the government should not interest itself in, say, helping people, is based on the idea that the government CAN not help people, which is nonsense. Government is the primary way that people since about the Late Bronze Age has structured their societies. There are winners and losers. Everything that the government does has an impact on people’s lives, and so does everything that the government doesn’t do. There is no “not doing anything,” since what looks like inaction is just another kind of action.

    This is crucial in health care, which is a market that exists in its current form (i.e. primarily funded by employer-provided insurance, which drives the actual price of goods and services well beyond actual market rates) because of decisions made by various government entities over the last 75 years. This is not a “free market.” It is a heavily subsidized market that is deeply biased against unsubsidized consumers. The ACA (“Obamacare”) does nothing to provide health care. All it tries to do is provide health insurance so that currently unsubzidized consumers can afford health care on the same terms as subsidized ones.

    So, to say that it is somehow wrong to use the government to reduce a market inequity that the government created makes no sense at all. In a thousand different ways, the government has acted in the last 75 years to privilege one group of people. As a result we have a health care system that has been enormously subsidized towards that group’s interests. To come into this network of actions and decisions and pretend that we live in some kind of free market utopia–and then try to use Libertarian fairy dust to make the government disappear, leaves the thousand other actions in place and eliminates the one action meant to mitigate the inequities that those actions created. This is not “keeping the government out of health care.” It is “making sure that the government ensures that some people get health care and some people don’t.”

    2) The second big problem with the Libertarian fairy dust model of government is that, as Chadwick says above, it turns “the government” into a “them” when the fundamental idea of our democratic system is that the government is us. Conservatives and libertarians should spend less time worshiping the Federalist Papers and actually read them. If they did, they would find that the Founders very clearly intended for government to be the mechanism by which people enacted their values in the public sphere. If we are a people who believe that it is important to do things like make sure that people have food, shelter, and life-saving medical treatments, then we have a moral obligation to use all of the tools available to us to make sure that people have food, shelter, and health care. In any society more advanced than a Pleistocene tribe, this is going to occasionally involve using the government–the primary mechanism by which people in modern societies structure the societies that they live in.

  19. Ojiisan says:

    “Zion, because they were of one heart and one mind, and dwelt in righteousness; and there was no poor among them.”

    Zion is about changing hearts and minds and bringing people to righteousness with the result of that change in hearts and minds and righteousness being no poor among them.

    You can use the government to assist the poor or help the sick by requiring people to pay (and there are some arguments in favour of doing so) but let’s not confuse that with building Zion by changing hearts and minds and bringing people to righteousness because it is not even close to being the same thing.

  20. Loursat says:

    I once would have nodded in agreement with Ojiisan’s comment. No longer. Now I believe that we are trapped if we think that equality comes only after our hearts and minds are changed, and only after we are “brought to righteousness.” The way things actually work is different.

    The striving for equality is an indispensable part of what purifies us. Zion is not the magical product of pure hearts. Zion is what we get as part of a long, sweaty process of sacrifice, risk, and experimentation. And Enoch’s path to Zion is not ours. Our path to Zion is the one that works for us in our time. We have to figure it out, one day at a time. Every day we must find better ways to feed each other, to care for each other, to educate each other. If ideology leads us to reject the means of accomplishing this, then we don’t deserve Zion, and we don’t deserve to be purified.

  21. I agree with Carolyn’s suggestion (4:33am) of being better informed about our government spending and taking steps to put our money where our priorities are. Considering myself under-informed on government spending I gleaned this breakdown from the CBO’s budget infographic (updated Feb 2017).

    24% Social Security (doesn’t include earmarked receipts, which slightly exceed payouts at present)
    15% Medicare
    10% Medicaid
    15% Other “mandatory” spending (benefit programs e.g. federal retirement, unemployment compensation, etc.)
    6% Interest
    15% Defense
    16% Other “discretionary” spending (annual appropriations e.g. education, science, infrastructure, etc.)

    Clearly our government (and indirectly us as taxpayers) are already spending significant money on healthcare. Should we be spending more? Maybe. Can we do so in a better way? Probably. Are there disagreements about which direction to move from the current situation? Undoubtedly. The OP makes a strong case for moving towards so many other western countries but it will be a tough sell given the already-large outlays.

  22. let’s not confuse that with building Zion by changing hearts and minds and bringing people to righteousness because it is not even close to being the same thing.

    That’s true. At the same time, a society in which one is free to refrain from contributing to the common good because one hasn’t yet discovered idiosyncratic reasons for doing so sounds like a hellscape of lowest common denominator egoism:

    Injured Traveler: Help!

    Able-bodied Traveler: Sorry man, just not feeling it today. Besides, it looks like you might be complicit in your own suffering and that’s really off-putting.

    Injured Traveler: C’mon, just do the Christian thing before it’s too…

    Able-bodied Traveler: Surely you wouldn’t want to force me into helping you? We must remain free to choose or we all go to hell!

  23. Carolyn says:

    ^^^ a certain Good Samaritan parable exists for that exact reason

  24. Maryanne says:

    I have been horrified to see how the words ‘self reliance’ are used to justify turning our backs on the poor and the needy. One of my co-workers, a Relief Society president, explained to me why it was okay for the medical student and his wife to use Medicaid for their healthcare because the government required them to have insurance, but not for the single parent to accept the same aid. The poor were slouchers living off others. Those tax breaks made one users, but the tax breaks given for home ownership or the child tax credit were good things for middle class families, and deserved. I came to realize that just as racism could be concealed by code words, contempt for the poor is being papered over with zeal for ‘self reliance.’ Count me out.

  25. Very good point that government may not be efficient in the way we usually think of that term, but it seems to be the most efficient entity to dispassionately offer health care benefits to the most people. Even though I’m conservative, I didn’t fight the ACA because the bottom line is I would like everyone to have health care. But that means the middle to upper class are going to have to pay more and/or get worse health care than they get now as the privileged class. You can’t get something for nothing. Our entire citizenship could be atheist and the same principles would apply.

  26. What role does the private insurance industry play in hiking up health care costs? Any? (A non- rethorical question from a curious Swede.)

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